Overview of medical insurance remote settlement

Non-local settlement of medical insurance means that when the insured person seeks medical treatment in a non-insured place, the medical expenses are settled directly through the medical insurance system, without the need to advance and then return to the insured place for reimbursement. This policy aims to solve the problem of "traveling money" for people to seek medical treatment across regions. It is an important measure to provide convenient medical insurance services. The main contents includeApplicable people(Such as relocating retired personnel and permanent staff in other places, etc.),Settlement scope(Inpatient, outpatient chronic disease, etc.),Process(Recording, holding card for medical treatment) andThings to note(Differences in filing validity period and settlement ratio). The following will be analyzed in detail in four parts.

Applicable scenarios and groups of people for remote settlement of medical insurance

Off-site settlement mainly serves four types of people:Long-term residents in other places(such as the elderly who move with their children),Referral personnel from other places(Due to illness requiring inter-provincial treatment),Temporary out-of-towners(Business trip, travel emergencies) andFlexible employment staff(such as those who work across provinces). Taking hospitalization expense settlement as an example, the national inter-provincial direct settlement rate will exceed 70% in 2023, covering all coordinated areas. It should be noted that outpatient fee settlement is currently limited to five types of chronic diseases such as hypertension, and general outpatient services must be implemented in accordance with local policies.

Process and required materials

Three steps need to be completed to achieve remote settlement:Filing first(Through the "National Medical Insurance Service Platform" APP or offline window),selected point(Choose hospitals that are connected to the national off-site medical settlement system),See a doctor with your card(Social security card or electronic medical insurance voucher). Registration materials usually include ID cards, proof of residence, or referral forms. Some areas support the "commitment system" that requires no materials. For example, insured persons in Beijing who seek medical treatment in Shanghai can directly swipe their medical insurance card to settle the bill after registration. The reimbursement ratio is in accordance with Beijing's policies, but the drug catalog adopts Shanghai standards.

Frequently Asked Questions and Notes

Things to note in actual operation:Registration validity period(Temporary outing is usually 6-12 months),settlement difference(The deductible and reimbursement ratio may be lower than those in the insured place),Emergency special circumstances(Emergency emergencies that have not been registered can be registered). According to data from the National Medical Insurance Administration, inter-provincial settlement will shorten the reimbursement time by an average of 20 working days in 2022. If the settlement fails, you can return to the insured place for manual reimbursement with the invoice stamped by the hospital, but the cycle will be longer.

Summary and policy outlook

The off-site settlement of medical insurance has significantly improved the convenience of medical treatment, but there is still room for optimization, such as expanding the scope of outpatient settlement diseases and simplifying the filing process. National Medical Insurance Administration plans to promote in 2024"Record-free" pilot, it is expected to realize a "national medical card" in the future. It is recommended that insured persons understand the policy differences between the two places in advance, check the list of designated hospitals through official channels (there are more than 50,000 nationwide), and make full use of this policy to benefit the people.

Quote sources:
1. National Medical Security Administration's "Notice on Further Improving the Direct Settlement of Basic Medical Insurance for Inter-Provincial and Non-local Medical Treatment" (2022)
2. "The 14th Five-Year Plan for National Medical Security" by the General Office of the State Council
3. China Medical Insurance Research Association’s “2023 National Out-of-Place Medical Settlement Operation Analysis Report”